Application Form for Incoming Students – AY 2018-2019 To fill the form please use only english alphabet letters AY 2018-2019 Application Form for Incoming Students If you are human, leave this field blank. APPLICATION (To fill the form please use only English alphabet letters and please use names as in your id/passport) Family Name/s * Name/s * Email * ID Card – Passport * NumberNumber ID Card – Passport * date of expiredate of expire Sex * M F Nationality * Date of Birth - Day/Month/Year * Place of Birth - City * Place of Birth - Country * Address for correspondence - Street * Address for correspondence - City * Address for correspondence - Postal Code (number) * Address for correspondence - Country * Phone number * International prefixInternational prefix International Prefix Phone number * Home NumberHome Number Home Number Phone number * Mobile NumberMobile Number Mobile Number Period of Stay * Second Semester Duration of stay - total months (in Number) * Duration of stay - FROM - Day/Month/Year * Duration of stay - TO - Day/Month/Year * Programme * Erasmus+ for study Erasmus+ for traineeship Erasmus + KA107 Globus for study Globus for traineeship Proposal subject to study in Cagliari * I wish to take courses Do a project work/thesis do a traineeeship Level * Bachelor Master phd - Doctoral Country of your University * Name of your University * Erasmus code of your university * Field of study * Field of study code * Departmental Coordinator Name Tel Fax e-mail * Institutional Coordinator Name Tel Fax e-mail * MEDICAL INSURANCE You should send a copy of the medical insurance that you have I have the European Health Card ? * No Yes, If Yes Nr:Yes, If Yes Nr: Do you have a disability/special needs (including dyslexia)/medical condition? * No Yes, Please state details of this disability/special need/medical condition:Yes, Please state details of this disability/special need/medical condition: If you require any special assistance as a consequence of condition stated above, please outline there LANGUAGE COMPETENCE Mother Language * ITALIANO - I am currently studying this language * Yes No ITALIANO - I have sufficient knowledge to follow lectures * Yes No ITALIANO - I would have sufficient knowledge to follow lectures if I had some extra preparation * Yes No Photo and ID Check the box and upload the documents(Not more than 8 mbyte are allowed) * Photo ID Card or Passport EHIC - European Health Insurance Card - (if possessed) upload here your ID card/passport AND the photo * Caricamento dei file. Attendere... Trascina qui il tuo file o fai clic per caricarlo Scegli file Dimensioni massime caricamento: 9.8MB. UPLOAD LIMIT: 9.8 MB.